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SANJAY GUPTA MD
Hard Hits; PSA Screening for Prostate Cancer; "Eat Like There's No Tomorrow"
Aired October 15, 2011 - 07:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, HOST: Good morning and thanks for joining us. I'm Dr. Sanjay Gupta on assignment here in San Francisco.
Concussions and kids -- it's a topic we cover quite a bit here on SGMD. Something we're very serious about. I want to tell you about a story about an agonizing decision that one family had to make to try and help others.
Also, the hunt for a new killer virus. It's taking place right now in central Africa. And that data is being analyzed here in San Francisco. We'll explain.
And also, another story that we've talked quite a bit about is about cell phones and radiation. Here in San Francisco, starting this month, these flyers like this are going to need to be handed out and on display in stores. Take a look. "Cell phones emit radio-frequency energy."
You're going to start seeing those here in San Francisco, along with specific tips on what to do about it, including limiting cell phone use by children, using a headset, using belt clips, avoiding cell phones in weak signal areas.
Look, this is something, again, we've been reporting on for some time. Concern that using a cell phone for too long, too many years could potentially problematic to your health. The World Health Organization even weighing in on this earlier this year saying they now consider cell phone radiation, the non-ionizing radiation, a plausible carcinogen -- something that could cause cancer.
So, at least here in San Francisco, you're going to see flyers like this for some time to come.
So exactly how do we best protect kids from head injuries, especially head injuries related to sports? Scientists are making incredible headway trying to link these hits on football fields, for example, with mood swings, with depression, with even suicide -- something that we've talked about quite a bit. There is a signature injury, and we're starting to see it in people younger and younger.
But here's the problem: we don't know exactly how common this injury is because as things stand now, it can only be diagnosed after death.
GUPTA (voice-over): Chronic traumatic encephalopathy, CTE, it's a progressive disease.
DR. ANN MCKEE, CO-DIRECTOR, VA CSTE BRAIN BANK: It spreads throughout the nervous system with aging, and I think we're starting to be able to match up clinical symptoms with the amount of spread in the brain.
GUPTA: Dr. Ann McKee has made it her life's mission to understand why some players are susceptible to CTE, and others are not. She's a director of the V.A. CSTE Brain Bank. It's a joint project between the Veterans Administration and Boston University.
(on camera): When you think about Alzheimer, you think about characteristic changes.
GUPTA: You're starting to see some of those same types of changes in people that are younger as a result of --
MCKEE: Of repetitive trauma to the brain. It's not the same distribution. And it doesn't affect the same parts of the brain, but we do see some characteristic shrinkage.
GUPTA: But what we're seeing here, is this definitely caused by blows to the head?
MCKEE: It's never been seen in any reported case except in a case of repeated blows to the head.
GUPTA: I think the remarkable thing is how early in life some of these changes can start to take place. What's the youngest that you've seen some of these early signs of what people are calling CTE or sort of a dementia-like thing?
MCKEE: The youngest case to date is a 17-year-old.
GUPTA: The brain of Nathan Stiles.
MCKEE: Which is Nathan Stiles, right.
GUPTA (voice-over): For Nathan Stiles, 2010 was supposed to be his year. The 17-year-old senior from Spring Hill, Kansas, was the star running back for his high school football team. He was also a starter on the varsity basketball team.
RON STILES, NATHAN'S DAD: If you would watch him run, he had a flow about him that was just beautiful. I mean, it looked so graceful.
CONNIE STILES, NATHAN'S MOM: He was an athlete, but school was more important. His grades and a future and a family and he just had his priorities right.
GUPTA: On Friday, October 1st, 2010.
ANNOUNCER: The 2010 homecoming king is -- Nathan Stiles.
GUPTA: The Spring Hill Broncos lost that game.
C. STILES: The next day he told me he had a headache. And I said, oh, really? He said oh, yes, I think I just got knocked around. I'm, like, OK.
And I got a call that Wednesday, that following Wednesday from the trainer at school saying Nathan's telling me he's still having headaches. You need to go take him to the emergency room.
So I did, had a CAT scan. Nothing.
GUPTA: Despite a clean CT scan, the doctor kept Nathan out of play for three weeks.
C. STILES: I remember him looking at me and he goes, "Mom, are you OK with this?" and I'm, like, "Well, no, but it's his choice." You know, it's his choice.
Nathan, you want to play? "Yes, I'm all right. Yes. I've only got, you know, two games left. I'm going to play."
So he did.
GUPTA: He took a hit that next game. But he seemed to be fine.
Nathan played the final game of the Broncos' season the following week. And just before halftime as Nathan went to intercept the ball, another hit.
C. STILES: He collapsed on the sideline. And the coaches were telling me to, you know, try to get -- wake him up. Try to wake him up. Then I heard him say, "He's seizuring," and that was it.
They took him in the ambulance. We waited for Life Flight. And everything went bad from there -- from bad to worse.
GUPTA: Nathan's brain hemorrhaged significantly, and his doctors could not save him. Nathan died of second-impact syndrome, a condition that occurs when a player is hit again too soon after a concussion. It primarily impacts younger athletes like Nathan.
R. STILES: If there's anything that needs to be learned -- if there's anything we can do to keep somebody's family from getting involved in what happened to us, we'd love to help do that.
MCKEE: You know, he was just an amazing young man who just loved the play of sports, and unfortunately had some fairly minor injuries that most likely resulted in his death.
GUPTA: I mean, I have kids as well. I mean, I think the hard part is, you know, you hear that. You hear that relatively minor injuries, healthy kid. And then he dies.
GUPTA: And I think the question for a lot of parents is what's the message to me?
MCKEE: The message is, you know, take care of your head. Don't play with your head. Play smart. Play safe.
And if you do get a head injury, even if it's really mild, you take care of that injury.
GUPTA: Just incredibly tough decisions that families are trying to make every single day. They're asking -- literally asking that very question. And sometimes they don't like the answers they always get.
One of the things we're working on is trying to figure out, can high school teams play safer and still win? It's a real -- it's a national movement. In fact, I'm flying from here to North Carolina to try and answer that very question. I'm going to have a series of reports on this and also a full documentary next year.
An interesting headline there right here in the Golden State: children under the age of 18 can no longer use a tanning bed even with their parents' permission -- a bit of a controversial decision. And California is the first state to do it. But they're doing it because of the concerns obviously about cancer.
Now, it's worth pointing out and remembering at this point that ultraviolet light is the real culprit, whether it comes from natural sunlight or from a tanning bed because it is tanning itself that poses the risk.
We're going to take a short break. But when we come back, we're going to discuss this controversial new recommendation that men no longer get a PSA test for prostate cancer screening. Not everyone agrees with this. And a lot of people are confused -- even me to some extent. So we're going to get it sorted out.
Stay with us.
GUPTA: Now a story that we first broke here on CNN involving one of the most common screening tests for cancer in the world today. It's called the PSA test, prostate-specific antigen test. A federal task force basically says don't do it. It could cause more harm than good.
These recommendations came as a surprise to many people out there, especially in the cancer community.
So, to sort of dive into this a little bit deeper, we're joined by two doctors, both from the University of California-San Francisco: Dr. Kirsten Bibbins-Domingo, who is a professor, doctor of medicine, epidemiology and statistics, and also Dr. Pete Carroll who chairs the urology department right here in San Francisco.
So, Dr. Carroll, let me start with you. Obviously a lot of news about the PSA test. The message people seem to be taking is that it could do more harm than good. And that really no one should be getting it on a regular basis.
What do you say to that news, first of all, those recommendations?
DR. PETER CARROLL, CHAIR OF UROLOGY DEPARTMENT, UC SAN FRANCISCO: I think the first part may be accurate for some patients. I think the second part to abandon PSA testing will set us back. We've seen a 40 percent reduction in prostate cancer mortality in the past two decades. I don't think we want to go backwards. I think ending PSA testing completely is the wrong thing to do.
GUPTA: In your practice, will you still order the test?
CARROLL: Yes. I'll order it in well-informed patients who are at risk for the disease. The other important thing is if they're found to have prostate cancer, we will treat selectively. That is that one of the big Achilles heels of PSA testing is the fact that you identify some cancers from not needing to be treated.
In this country, they're often treated. That's the down side. We need to stop that. If we stop that, we can PSA more intelligently.
GUPTA: What about that Dr. Domingo? Instead of abandoning the test completely as Dr. Carroll suggesting, and being smarter about it, not completely linking diagnosis and treatment, figuring out who needs to be treated.
DR. KIRSTEN BIBBINS-DOMINGO, ASSOCIATE PROFESSOR OF MEDICINE, UC SAN FRANCISCO: Yes, that's a great point. The thing -- the job of the task force was to look at our current practice of using PSA screening in healthy men without symptoms and to evaluate the evidence of whether there's reduced mortality after we screen in this fashion.
And what we found was that there wasn't evidence for reductions in deaths as a result of the screening. And, in fact, the harms that come from over-diagnosis and from overtreatment, as Peter said, outweigh the benefits that don't seem to be in existence in screening all men.
GUPTA: I want to be sure that I'm clear on this, though, because Dr. Carroll, you mentioned 40 percent reduction in mortality over the past couple of decades. It says no reduction due to PSA testing.
What was the reduction due to over the last 20 years?
CARROLL: I think in my opinion that clear evidence that PSA does save lives. One could argue what that benefit is. I think well- conducted studies will show that.
I think it's in part due to early detection and in part due to improved treatment. So I think in combination, we've lower mortality rates. Actually, the reduction in prostate cancer mortality has accounted for 20 percent of the global reduction in cancer deaths in men. Again, I don't think we want to go back there.
GUPTA: Well, stay tuned, right? I think we're going to add to the public discussion, as you requested.
Doctor Domingo, thanks so much.
DOMINGO: Thank you very much.
GUPTA: Dr. Carroll, appreciate it. Thank you.
CARROLL: Thank you.
DOMINGO: Thank you.
GUPTA: Now, I may remember I was in this film called "Contagion." It was about a pandemic that sweeps the planet -- unsettling movie for sure, a little frightening. But you're about to meet a scientist who's made it his life's work to try and prevent that exact scenario from happening. We first met in the jungles of Africa, Nathan Wolfe. He's coming up.
But, first in this week's "Food for Life": brain food.
GUPTA (voice-over): You are what you eat. And that's especially true in the brain, which is mostly made up of fatty tissue. No surprise, then, research shows that healthy brain function is linked to a healthy mix of fats in your diet.
Crucial to that mix, omega 3 fatty acids. At least one military study showed levels that are too low are tied to depression, even higher suicide rates.
So the question is, how do you get enough? Well, the best source by far is seafood. Salmon is a good one, sardines as well. Now, if you hate fish, there are eggs with omega 3s added. Of course, you can always take a supplement.
That's "Food for Life."
GUPTA: We are back with SGMD.
I'm on assignment here in San Francisco. You know, there's probably no city that has such a link between technology being used to solve these old problems using new ideas and new techniques. It's true in many fields including medicine, and specifically infectious diseases.
The man you're about to meet, well, he does his work here. Of course, he's not here right now. He's touring the country promoting his new book called "The Viral Storm."
Nathan Wolfe joins me from New York.
There are so many new pathogens out there. And it's striking, just this week we heard about 43,000 -- I'm reading here -- 43,381 new viruses researchers found. We really only have sort of looked more closely at fewer than 10,000 of them.
What does that mean that there are so many more pathogens being discovered?
NATHAN WOLFE, AUTHOR, "THE VIRAL STORM": I mean, part of what this means is we have new technology available. So if you look back even 20, 30 years ago, all we had was culture.
Now, we have these incredible new genomic technologies that allow us to take a specimen, maybe a swab of skin from my hand, maybe it's a drop of water, and to really get a sense of the viruses present in those kinds of specimens. That's going to change the way we can detect them early and change the way that we can ultimately predict and possibly even prevent future pandemics.
GUPTA: You and I have spent time traveling around the world, including in Africa, in Cameroon, for example. You spent a lot of time there looking specifically at some of these -- some of the chatter I believe you called it of these pathogens going back-and- forth between animals and humans.
Your research, obviously, has been in this area for some time.
What is happening in those areas? Are there constant leaps being made from animals to humans that could be problematic?
WOLFE: Yes. And some of it is things are changing, right? So all of these pandemics ultimately originate in animals, as have the majority of human diseases in history. And, as sort of roads go further out and we have more contact with these animals, more and more viruses are going to be jumping into us.
But perhaps even more important is interconnected nature of our planet, so the way that airlines and ships really connect human populations mean that -- in the sort of blink of an eye, a virus from Central Africa or Southeast Asia or South America could make its way anywhere on the entire planet, and that's what we really have to be concerned with.
GUPTA: Yes. And I don't know if you saw this. There's a recent movie "Contagion" which talked about, you know, this sort of this idea in an area of global travel.
You're one of the guys trying to keep us safe, I think, by providing us more information. That's part of what your shop does here in San Francisco.
Can you tell us about it? So, what is the shop doing here in San Francisco? How does it relate to what's happening in places like Africa?
WOLFE: Yes. No. And as you may know I was one of the advisers on "Contagion." It was a really interesting exercise.
You know, basically, if you kind of think about it, what we do in San Francisco is we're sort of the prequel, if you will, to "Contagion." You know, our objective is to try to stop these viruses before they get to a pandemic stage.
So, if we do our job right, movies like "Contagion" or at least the real-life scenarios won't have to happen.
GUPTA: So what would happen instead? I mean, so you have this shop that's monitoring chatter. What happens next? How do you prevent the pandemic from occurring? Because it all seems to happen so quickly or could happen so quickly.
WOLFE: Yes. No. And it just depends on the nature of the pandemic. So, yes, it's all about early detection. So, if you think about early detection, it's sort of like compounding interest -- sort of the earlier you detect something, the more lives you save at the -- you know, in the long run. Just in the same way that compounding interest, you start saving early, you get more money at the end.
And this is basically -- you know, this is what we're all about and whether it's sort of digital surveillance using digital tools, whether it's, you know, monitoring the movement of these viruses from animals to humans in, you know, 20 or some sites that we work with around the world.
Our job is to catch these. We are obviously linked very closely with organizations like our partners at CDC, USAID, organizations like the WHO, where we participate in the global outbreak alert and response network. So, you know, the idea is to try to trigger these.
But, historically, we have been very good or at least tried really hard at responding. The real question is can we move towards prediction like we did with heart disease during the '70s and '80s? Well, we're not there yet, but that's where we're trying to go.
GUPTA: That's fascinating.
Well, I'm glad you're around, Nathan, doing the sort of work that you're doing. Hopefully, it will keep us all a little bit safer.
Congratulations on the book. I'll try to keep things under control for you in San Francisco while you are away. Beautiful spot. But thanks so much for joining us.
And next up, a chef with no stomach. We'll explain right after the break.
GUPTA: A lot of houses have more than one cookbook, right? I think we have several cookbooks in our home. I think the less you cook, the more books you buy apparently. But the book I'm about to tell you about is a really unusual one. It was written by a chef while he was in the hospital being treated for cancer of his stomach.
His name is Chef Hans Rueffert and this whole thing changed everything about him, including how he eats.
GUPTA (voice-over): Hans Rueffert is a chef without a stomach or much of an esophagus.
HANS RUEFFERT, CHEF: I've had 11 surgeries in the last six years.
GUPTA: You see, Rueffert was diagnosed with gastric cancer just weeks after appearing in the 2005 season of "The Next Food Network" star.
RUEFFERT: There was a tumor sitting right at the junction of the stomach and esophagus.
GUPTA: His treatment was painful. Rueffert had half his stomach and most of his esophagus removed immediately after his diagnosis. And then there were more operations -- chemo, radiation -- but eventually he was cancer free. That's when the headaches began.
RUEFFERT: They saw 10 to 12 lesions and was told, this is it. You've got -- you're on your way out.
GUPTA: It wasn't cancer, but it was a serious brain infection caused by his newly constructed digestive system.
RUEFFERT: I ended up springing a leak at that junction where the esophagus and stomach were connected and that leak actually almost killed me.
GUPTA: Antibiotics got rid of the infection. But a year later, a second one, worse than the first. Both infections were so serious that doctors didn't want to risk him getting yet another one.
So, on March of this year, the rest of Rueffert's stomach was removed. Even though his stomach is gone, he eats six healthy small meals every day which now go directly into his intestines.
RUEFFERT: The expression you are what you eat is so -- you know, it's cliche as it can be, and it's cliche because it's true. And for me that really is amplified.
GUPTA: He wrote a cookbook while in the hospital after his first operation. And for the last five years, he's been teaching fellow survivors how to incorporate healthy, cancer-fighting foods into their diets.
RUEFFERT: It's power and it's energy and it's energy that our bodies can readily assimilate even for a guy without a stomach.
GUPTA: Rueffert says the six years had been difficult, but being open his cancer and surrounding himself with family and friends has helped him overcome every challenge so far.
RUEFFERT: Somehow you just kind to find a little more strength just to keep -- keep going, keep going and keep going, you know, and here we are. I just had my six-year check-up and we're six years cancer-free.
GUPTA: Chef Rueffert helps run his family's restaurant. It's called the Woodbridge Inn, about an hour north of Atlanta.
That's it for us today.
Time to get you now to the CNN NEWSROOM for a check of your top stories making news right now.